Chapter 15: Schizophrenia Spectrum And Other Psychotic Disorders

Front 1

Phase I of Schizophrenia

Back 1

Premorbid phase

Social maladjustment

Antagonistic thoughts and behavior

Shy and withdrawn

Poor peer relationships

Doing poorly in school

Antisocial behavior

Front 2

Phase II of Schizophrenia

Back 2

Prodromal phase

Lasts from a few weeks to a few years

Deterioration in role functioning and social withdrawal

Substantial functional impairment

Sleep disturbance, anxiety, irritability

Depressed mood, poor concentration, fatigue

Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis

Front 3

Phase III of Schizophrenia

Back 3

Schizophrenia

In the active phase of the disorder, psychotic symptoms are prominent

Delusions

Hallucinations

Impairment in work, social relations, and

self-care

Front 4

Phase IV of Schizophrenia

Back 4

Residual phase

Symptoms similar to those of the prodromal phase

Flat affect and impairment in role functioning are prominent

Front 5

Delusional Disorder

Back 5

Characterized by the presence of delusions that have been experienced by the individual for at least 1 month

Types: Grandiose, Jealous, persecutory, somatic

Front 6

Brief Psychotic disorder

Back 6

Sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor

lasts less than one month

Front 7

Substance induced psychotic disorder

Back 7

The prominent hallucinations and delusions associated with this disorder are found to be directly attributable to substance intoxication or withdrawal or after exposure to a medication or toxin

Front 8

The catatonic features specifier

Back 8

Catatonic features may be associated with other psychotic disorders

Stupor and muscle rigidity or excessive, purposeless motor activity

Waxy flexibility, negativism, echolalia, echopraxia

Front 9

Schizophreniform Disorder

Back 9

Same symptoms as schizophrenia

duration at least 1 month > 6 months

Front 10

Schizoaffective Disorder

Back 10

Schizophrenic symptoms plus mania or depression

Front 11

1. A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier?

a) Strong ego boundaries and abstract thinking

b) Ataxia and akinesia

c) Stupor, muscle rigidity, and negativism

d) Substance abuse and cachexia

Back 11

Correct answer: C

Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors.

Front 12

Delusions

Back 12

False personal beliefs

Front 13

Religiosity

Back 13

Excessive demonstration of obsession with religious ideas and behavior

Front 14

Paranoia

Back 14

Extreme suspiciousness of others

Front 15

Magical Thinking

Back 15

Ideas that one's thoughts or behaviors have control over specific situations

Front 16

Associative looseness (loose association)

Back 16

Shift in ideas from one unrelated topic to another

Front 17

Neologisms

Back 17

Made-up words that have meaning only to the person who invents them

Front 18

Concrete thinking

Back 18

Literal interpretations of the environment

Front 19

Clang Associations

Back 19

Choice of words is governed by sound (often rhyming)

Front 20

Word Salad

Back 20

Group of words put together randomly

Front 21

Circumstantiality

Back 21

Delay in reaching the point of communication due to unnecessary and tedious details

Front 22

Tangentiality

Back 22

Inability to get to the point of communication due to introduction of many new topics

Front 23

Mutism

Back 23

Inability or refusal to speak

Front 24

Perseveration

Back 24

persistent repetition of the same word or idea in response to different questions

Front 25

2. The client hears the word “match.” The client replies, “A match. I like matches. They are the light of the world. God will light the world. Let your light so shine.” Which communication pattern does the nurse identify?

a) Word salad

b) Clang association

c) Loose association

d) Ideas of reference

Back 25

Correct answer: C

Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.

Front 26

Hallucinations

Back 26

False sensory perceptions not associated with real external stimuli

Auditory

Visual

Tactile

Gustatory

Olfactory

Front 27

Illusions

Back 27

Misperceptions of real external stimuli

Front 28

Echolalia

Back 28

Repeating words that are heard

Front 29

Echopraxia

Back 29

Repeating movements that are observed

Front 30

Identification and imitation

Back 30

Taking on the form of behavior one observes in another

Front 31

Depersonalization

Back 31

Feelings of unreality

Front 32

Negative Symptoms

Back 32

Loss of normal function

Front 33

Affect

Back 33

The feeling state or emotional tone

Inappropriate affect: emotions are incongruent with the circumstances

Bland: weak emotional tone

Flat: appears to be void of emotional tone

Apathy: disinterest in the environment

Front 34

Volition

Back 34

Impaired ability to initiate goal-directed activity

Emotional ambivalence

Deterioration in appearance

Front 35

Impaired interpersonal functioning

Back 35

Impaired social interaction

clinging and intruding on the personal space of others

exhibiting behaviors that are not culturally and socially acceptable

Social isolation

Focus inward and exclusion of external environment

Front 36

Psychomotor behavior

Back 36

Anergia: deficiency of energy

Waxy flexibility

Posturing: voluntary assumption of inappropriate or bizarre postures

Pacing and rocking

Associated features

Anhedonia: inability to experience pleasure

Regression: retreat to an earlier level of development

Front 37

4. To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented?

a) Reinforce the perceptual distortions until the client develops new defenses

b) Provide an unstructured environment

c) Avoid making connections between anxiety-producing situations and hallucinations

d) Distract the client's attention

Back 37

Correct answer: D

The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.

Front 38

5. A client, diagnosed with paranoid schizophrenia, states, “My roommate is plotting to have others kill me.” Which is the appropriate nursing response?

a) “I find that hard to believe.”

b) “What would make you think such a thing?”

c) “I know your roommate. He would do no such thing.”

d) “I can see why you feel that way.”

Back 38

Correct answer: A

This client is experiencing a persecutory delusion. This nursing response is an example of “voicing doubt,” which expresses uncertainty as to the reality of the client’s perceptions. This is an appropriate therapeutic communication technique in dealing with clients who are experiencing delusional thinking.

Front 39

Typical Antipsychotics

Back 39

Haldol/Thorazine

Greater EPS SE: tardive dyskanisia, dystonia, ataksia, parkinsonism

EPS reversal: Cogentin and benadryl

Front 40

Atypical Antipsychotics

Back 40

Geodon/Seroquel/Clozaril/Risperdal/Zyprexa

Less EPS SE

Treats positive and negative symptoms of Schizophrenia

Front 41

6. A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order?

a) Paroxetine (Paxil)

b) Carbamazepine (Tegretol)

c) Benztropine (Cogentin)

d) Lorazepam (Ativan)

Back 41

Correct answer: C

Benztropine is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic medications.